95199
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Clinical documentation of clinically significant allergic symptoms and that testing is part of a complete diagnostic evaluation.
- Documentation from the licensed practitioner confirming scope-of-practice and justification for selected antigens (i.e., likelihood of member exposure).
- Record of number/units of tests performed to demonstrate compliance with state-specific unit limits or applicable NCCI MUE limits.
- Documentation of negative percutaneous (skin prick) test results when performing intracutaneous (intradermal) testing.
Key Coverage Criteria
- Supervision (including preparation) and provision of 150 allergen/antigen preparations or less per 12 months of subcutaneous allergy immunotherapy is consideredmedically necessaryfor the first year, including the build-up phase.
- Supervision (including preparation) and provision of 120 allergen/antigen preparations or less per 12 months of subcutaneous allergy immunotherapy is consideredmedically necessaryafter the first year as maintenance therapy.
- Allergy testing to determine immunologic sensitivity for immediate (IgE-mediated) hypersensitivity.
- Allergy testing to determine immunologic sensitivity for delayed (cell-mediated) hypersensitivity.
- Allergen immunotherapy (repeated administration of specific allergens) for patients with IgE-mediated allergic conditions to reduce allergic symptoms and inflammatory reactions.
- Allergy testing is medically necessary for members with clinically significant allergic symptoms as part of a complete diagnostic evaluation by a licensed practitioner acting within their scope.
6 Active Policies
AMBETTER-CP.MP.100 — Allergy Testing
A56424 — Billing and Coding: Allergy Immunotherapy
MED206.006 — Sublingual Immunotherapy as a Technique of Allergen-Specific Therapy
ANTHEM-LAB.00027 — LAB.00027 Selected Blood, Serum and Cellular Allergy and Toxicity Tests
ANTHEM-CG-MED-52 — CG-MED-52 Allergy Immunotherapy (Subcutaneous)
Related Codes
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